Do we need to D/C both heparin as well as warfarin..?
Few source say only heparin and other say both, confused. Can any make this clear...pls
Thanks
both if risk of bleeding
otherwise not
source:
http://www.guidelines.gov/summary/summar...oc_id=5891&nbr=3877
Vitamin K Antagonists (VKAs)
Management of Direct Thrombin Inhibitor (DTI)-VKA Overlap
For patients with strongly suspected or confirmed HIT, the guideline developers recommend against the use of vitamin K antagonist (coumarin) therapy until after the platelet count has substantially recovered (e.g., to at least 100 x 109/L, and preferably, 150 x 109/L); that the VKA be administered only during overlapping alternative anticoagulation (minimum 5-day overlap), and begun with low, maintenance doses (maximum, 5 mg of warfarin, and 6 mg of phenprocoumon); that the alternative anticoagulant not be stopped until the platelet count has reached a stable plateau, and with at least the last 2 days the international normalized ration (INR) within the target therapeutic range (Grade 1C).
Reversal of VKA Anticoagulation
For patients receiving VKAs at the time of diagnosis of HIT, the guideline developers recommend use of vitamin K (Grade 2C).
phew... i feel like i need a lawyer for this :-)